Anterior composite veneering. A minimally invasive approach to enhance the aesthetics.

Incisal embrasures are one of the most important factors that determine the aesthetics of a smile. They’re formed by the edges and the separations between the teeth and the dark background of the mouth. Their dimension and their volume increase as the dentition progresses distally from the midline. These embrasures tend to be reduced with age due to abrasion.
This patient presented to our clinic to enhance her smile. She complained of large incisal embrasures giving her the illusion of having diastemas and small teeth.

styleitaliano style italiano initial situation with oval shaped teeth

Fig.1
The clinical examination revealed:
– large incisal embrasures
– rounded teeth
– small and short laterals
– reduced incisal edges on the central and the lateral incisors
– surface irregularities

styleitaliano style italiano lateral view of lateral discussion guides

Fig.2
It is mandatory to always check the lateral movements in order to locate the safe zones eligible to receive the composite restoration without inducing occlusal interference that may lead to chipping of the restorations.

styleitaliano style italiano incisors isolated with rubber dam

Fig.3
No preparation of the teeth was needed because the aim was to add, rather than reduce in volume. The fullenamel surface was ideal to optimize the restorations’ longevity. A rubber dam was placed.

styleitaliano style italiano etching gel on teeth

Fig.4
Etching of the teeth was carried out with 37% phosphoric acid (Scotchbond, 3M/ESPE, St. Paul, MN, USA), following the total-etch protocol.

styleitaliano style italiano bonding teeth and light curing lamp

Fig.5
Afterwards, the adhesive single bond 2 (3M/ESPE, St. Paul, MN, USA) was applied in two consecutive layers, using a microbrush. A 5-second air blowing was performed after each layer to evaporate the solvent followed by light curing for 20 seconds using the Curing Pen by Eighteeth.

curing pen light style italiano styleitaliano eighteeth
curing pen light style italiano styleitaliano eighteeth
styleitaliano style italiano white dental beauty composite system

Fig.6
Two composite shades from CompoSite System by White Dental Beauty were used:
– Si 2, equivalent to A2, is the dentin shade used.
– Si E (Si Enamel), is used to give translucency and good opalescence properties to the restorations.

style italiano styleitaliano white dental beauty composite system
style italiano styleitaliano white dental beauty composite system
styleitaliano style italiano palatal composite shells

Fig.7
Since no major modifications were needed to correct the incisal edge, the freehand technique was used to build the palatal wall. Si E (Si enamel) was used.

styleitaliano style italiano palatal composite shells before proximal build up

Fig.8
After completing the incised contour of all the teeth, we were ready to complete the shape.

styleitaliano style italiano contouring with matrices for direct composite veneering

Fig.9
Two matrices were placed to ensure a good contact point and an adequate proximal contour of the teeth. Proximal walls were built using Si E with a total thickness of 1mm.

styleitaliano style italiano contoured teeth during composite veneering

Fig.10
The same procedure was repeated for all the proximal walls. Notice the new shape and length of the teeth.

styleitaliano style italiano proximal build up of canine medial wall

Fig.11
Proximal mesial wall on the left canine.

styleitaliano style italiano direct veneering contour step before layering

Fig.12
After all teeth were completely contoured, we were ready for final layering.

styleitaliano style italiano layering mamelons with composite

Fig.13
Si 2 was used to create the mamelons in the incisal edge of the laterals in order to avoid having highly translucent areas, and to give the restorations a natural appearance. To facilitate the modeling of the composite, the LM Solo Anterior Instrument (LM, powered by Styleitaliano) was used.

style italiano styleitaliano lm arte solo instruments
style italiano styleitaliano lm arte solo instruments
styleitaliano style italiano brushing composite enamel layer

Fig.14
Si E (Si Enamel) was placed at the end in order to give the restorations the needed translucency and the opalescence properties.

styleitaliano style italiano fine grit but creating surface anatomy in composite veneers

Fig.15
After drawing the transitional lines and the secondary anatomy with a pencil, excess composite was removed using a tapered round-tipped bur with an extra fine grit.

styleitaliano style italiano steps in texturing composite veneer surface

Fig.16
By rubbing an articulating paper on the buccal side, we are able to mimic the surface texture on all the teeth.

styleitaliano style italiano coarse disc finishing line angles

Fig.17
The coarse red grit from Sof-Lex (3M/ESPE, St. Paul, MN, USA) was used to define proximal contour of the teeth. These discs should be used with caution in order to avoid removing the contact point or the transitional lines.

style italiano styleitaliano 3m sof lex discs and diamond spirals polishing
style italiano styleitaliano 3m sof lex discs and diamond spirals polishing
styleitaliano style italiano medium grit disc prepolishing composite veneers

Fig.18
Light orange Sof-Lex disc from 3M ESPE was used to polish the proximal areas.

styleitaliano style italiano lucida composite polishing system for composite gloss

Fig.19
Final polishing using the Lucida Composite Gloss System by DiaShine and Style Italiano.

style italiano styleitaliano diashine lucida
style italiano styleitaliano diashine lucida
styleitaliano style italiano polished direct dental composite veneers

Fig.20
Final result.

Conclusions

Direct composite restorations can be an ideal conservative treatment to enhance shape and incisal embrasures of the teeth. The key criteria to succeed these cases are to memorize dental morphology and to master the different layers of composite (enamel, dentine, transparent…) in order to have an excellent and natural blend between the restorations and the teeth.

Bibliography

1. Devoto W, Saracinelli M, Manauta J. Composite in everyday practice: how to choose the right material and simplify application techniques in the anterior teeth. The European journal of esthetic dentistry 2010;5:102-124.
2. Manauta J, Salat A. Layers, An atlas of composite resin stratification. Quintessence Publishing Co; 2012
3. Dietschi D. Optimizing smile composition and esthetics with resin composites and other conservative esthetic procedures. Eur J Esthet Dent 2008; 3(1):14-29.
5. Dietschi D, Shahidi C, Krejci I. Clinical performance of direct anterior composite restorations: a systematic literature review and critical appraisal. The International Journal of Esthetic Dentistry 2019;14:252–270.
6. Foulger TE, Tredwin CJ, Gill DS, Moles DR. The influence of varying maxillary incisal edge embrasure space and interproximal contact area dimensions on perceived smile aesthetics. Br Dent J 209, 126–127 (2010).

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